Interpositional arthroplasty of the fourth and fifth tarsometatarsal joint with an autologous gastrocnemius aponeurosis graft: A surgical technique guide and case series

Abstract

Limited literature exists regarding the treatment for symptomatic osteoarthritis of the fourth and fifth tarsometatarsal joints. Reports regarding joint sparing procedures describe the use of interpositional autologous grafts from the peroneus brevis and peroneus tertius tendons, tendon allografts, and ceramic spherical implants, while arthrodesis remains cautiously reserved. This case study demonstrates an innovative surgical technique that displays the use of an autologous gastrocnemius aponeurosis graft between January 2016 and December 2020 for the treatment of symptomatic osteoarthritis of the fourth and fifth tarsometatarsal joint. Fifteen patients were included in the case study, no patients were lost to follow up. The average follow-up was 30 months with 40 % of patients returning greater than 3 years after their surgery date for unrelated complaints. The reported surgical technique can be performed as an isolated procedure; however, additional procedures can be performed as necessary depending on patient pathology. One postoperative complication was encountered secondary to non-compliance, but no patients required revision or re-operation. The surgical technique allows for preservation of adjacent normal anatomy without the use of a foreign body implant and provides a powerful advantage compared to other reported surgical techniques.